Advances in treatment of bacterial meningitis

Summary Bacterial meningitis kills or maims about a fifth of people with the disease. Early antibiotic treatment improves outcomes, but the effectiveness of widely available antibiotics is threatened by global emergence of multidrug-resistant bacteria. New antibiotics, such as fluoroquinolones, coul...

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Bibliographic Details
Published in:The Lancet (British edition) 2012-11, Vol.380 (9854), p.1693-1702
Main Authors: van de Beek, Diederik, Prof, Brouwer, Matthijs C, MD, Thwaites, Guy E, MD, Tunkel, Allan R, Prof
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - therapeutic use
Antibiotics
Bacteria
Bacterial diseases
Bacterial diseases of the nervous system. Bacterial myositis
Biological and medical sciences
Community-Acquired Infections - drug therapy
Community-Acquired Infections - epidemiology
Disease
Drug Therapy, Combination
Epidemiology
Forecasting
General aspects
Global Health
Gram-Negative Bacterial Infections - drug therapy
Gram-Positive Bacterial Infections - drug therapy
Human bacterial diseases
Humans
Hypothermia
Infectious diseases
Internal Medicine
Listeria
Medical sciences
Meningitis
Meningitis, Bacterial - drug therapy
Meningitis, Bacterial - epidemiology
Mortality
Penicillin Resistance
Recurrence
Streptococcus infections
Therapies, Investigational
Treatment Outcome
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Summary:Summary Bacterial meningitis kills or maims about a fifth of people with the disease. Early antibiotic treatment improves outcomes, but the effectiveness of widely available antibiotics is threatened by global emergence of multidrug-resistant bacteria. New antibiotics, such as fluoroquinolones, could have a role in these circumstances, but clinical data to support this notion are scarce. Additionally, whether or not adjunctive anti-inflammatory therapies (eg, dexamethasone) improve outcomes in patients with bacterial meningitis remains controversial; in resource-poor regions, where the disease burden is highest, dexamethasone is ineffective. Other adjunctive therapeutic strategies, such as glycerol, paracetamol, and induction of hypothermia, are being tested further. Therefore, bacterial meningitis is a substantial and evolving therapeutic challenge. We review this challenge, with a focus on strategies to optimise antibiotic efficacy in view of increasingly drug-resistant bacteria, and discuss the role of current and future adjunctive therapies.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(12)61186-6